Background <p>Breastfeeding is widely recognized as protective against infectious morbidity in infancy, largely through immunologic, anti-inflammatory, and microbiome-mediated mechanisms. Whether exclusive breastfeeding also influences the risk of <i>perianal abscess</i>, a relatively common condition in early infancy, remains unclear. This study aimed to evaluate the association between infant feeding patterns and the development of perianal abscess.</p> Methods <p>This retrospective case–control study with age-frequency matching was conducted at a tertiary pediatric surgery center and included male infants aged 0 to 6 months diagnosed with perianal abscess between January 2020 and December 2025. Epidemiologic characteristics, recurrence rates, microbiologic findings, and feeding practices (exclusive breastfeeding, exclusive formula feeding, or mixed feeding) were collected and compared. Logistic regression was used to assess the association between feeding pattern and odds of abscess, adjusting for age and prematurity.</p> Results <p>Mean age was similar between groups (2.3 vs. 2.5 months). Among infants with perianal abscess, 46% were exclusively breastfed, 23.6% exclusively formula-fed, and 30.3% mixed-fed. In controls, the corresponding rates were 39%, 40%, and 21%, respectively. Overall feeding distribution did not differ significantly (<i>p</i> = 0.056). Exclusive breastfeeding was not associated with reduced odds of abscess (OR 0.81; 95% CI 0.38–1.73), whereas exclusive formula feeding was associated with lower odds compared with mixed feeding (OR 0.40; 95% CI 0.18–0.91).</p> Conclusions <p>In this cohort of male infants under six months, exclusive breastfeeding did not appear to protect against perianal abscess. Mixed feeding was more common among affected infants, which may reflect the transient microbiologic shifts that occur during partial weaning or combined feeding.</p>